[NOVEMBER-2018]

AYUSHMAN BHARAT-PMjAY: INDIA’S ANSWER TO UNIVERSAL HEALTH CARE

India has achieved significant public health gains and improvements in health
care access and quality over the last three decades. The health sector is
amongst the largest and fastest growing sectors, expected to reach US$ 280
billion by
2020. At the same time, India’s health sector faces immense challenges. It
continues to be characterized by high out-of- pocket expenditure, low financial
protection, low health insurance coverage amongst both rural and urban
population. It is a matter of grave concern that we incur a high out-of-pocket
expenditure on account of health and medical costs. 62.58% of our population has
to pay for its own health and hospitalization expenses and are not covered
through any form of health protection. Besides using their income and savings,
people borrow money or sell their assets to meet their healthcare needs, thereby
pushing 4.6% of the population below the poverty line. The Government is
committed to ensure that its population below the poverty line. The Government
is committed to ensure that its population has universal access to good quality
health care services without anyone having to face financial hardship as a
consequence.

To ensure that nobody is left out, their will be no cap on family size and age
in the Mission. The scheme is cashless & paperless at public hospitals and
empanelled private hospitals. The beneficiaries are not required to pay any
charges for the hospitalization expenses. The benefit also includes pre and
post-hospitalization expenses. The scheme is entitlement based, the beneficiary
id decided in the basis of family being figured in SECC database. When fully
implemented, the AB-PA-JAY will become the world’s largest government funded
health protection mission.

The initiatives are as follows:-

Health and Wellness Centre:- The National Health Policy, 2017 has envisioned
Health and wellness Centres as the foundation of
India’s health system. Under this, 1.5 lakh centres will bring care system
closer to the homes of people. These centres will provide comprehensive health
care, including for non-communicable diseases and maternal and child health
services. These centres will also provide free essential drugs and diagnostic
services. The Budget has allocated Rs. 1200 crore for this flagship programme.
Contribution of private sector through CSR and philanthropic institutions in
adopting these centres is also envisaged.

National Health Protection Scheme:- The second flagship programme under Ayushman
Bharat is National Health Protection Scheme, which will cover over 10 crore poor
and vulnerable families providing coverage upto 5
lakh rupees per family per year for secondary and tertiary care hospitalization.
This will be the world’s largest government funded health care programme.
Adequate funds will be provided for its smooth implementation.

The Finance Minister further said, that these twp health sector initiatives
under Ayushman Bharat Programme will build a New India 2022 and ensure enhanced
productivity, well being and avert wage loss and impoverishment. These Schemes
will also generate lakhs of jobs, particularly for women.

In order to further enhance accessibility of quality medical education and
health care, 24 new Government Medical Colleges and Hospitals will be set up, by
upgrading existing district hospitals in the country. This would ensure that
there is at least 1 medical college for every 3 Parliamentary Constituencies and
at least 1 Government Medical College in each State of the country.

Implementation Strategy: At the national level to manage, an Agency would be put
In place. States/ Uts world be advised to implement the scheme by
a dedicated entity called State Health Agency (SHA). They can either use an
existing Trust/ Society/Not for Profit Company/State Nodal Agency (SNA) or set
up a new entity to implement the scheme. States/UTs can decide to implement the
scheme. States/UTs can decided to implement the scheme through an insurance
company or directly through the Trust/Society or use an integrated model.

Major Impact: In- patient hospitalization expenditure in India has increased
nearly 300% during last ten years. More than 80% of the expenditure are met by
out of pocket. Rural household primarily depended on their ‘household
income/savings’ and on ‘borrowings’, the urban households relied much more on
their ‘income/saving’ for financing expenditure on hospitalizations, and on
borrowings. Out of pocket expenditure in India is over 60% which leads to nearly
6 million families getting into poverty due to catastrophic health expenditures.
AB-PMJAY will have major impact on reduction of Out Of Pocket (OOP) expenditure
on ground of:

Increased benefit cover to nearly to nearly 40% of the population,
Covering almost all secondary and many tertiary hospitalizations,
Coverage of 5 lakh for each family,

This will lead to increased access to quality health and medication. In
addition, the unmet needs of the population which remained hidden due to lack of
financial resources will be catered to. This will lead to timely treatments,
improvements in health outcomes, patient satisfaction, improvement in
productivity and efficiency, job creation thus leading to improvement in quality
of life.

“Ayushman Bharat-NHPM is in synergy with NHM and will strengthen public health
infrastructure. Various measure like identity validation through Aadhaar, cost
control etc., make the Ayushman Bharat easily accessible and transparent in
approach. The Health Minister said that Ayushman Bharat-NHPM will also
strengthen spirit of cooperative federalism. “NHPM provides ease to be merged
with the ongoing health protection or insurance schemes in various ministries
and governments.”

Expenditure involved:

The expenditure incurred in premium payment will be shared between Central and
States Government in specified ratio as per Ministry of Finance guidelines in
vogue. The total expenditure will depend on actual market determined premium
paid in States/Uts where AB-NHPM will be implemented through insurance
companies. In States/Uts where the scheme will be implemented in Trust/Society
mode, the central share of funds will be provided based on actual expenditure or
premium ceiling in the predetermined ratio.

Number of Beneficiaries: AB-PMJAY will target about 10.74 crore poor, deprived
rural families and identified occupational category of urban workers families as
per the latest Socio-Economic Caste Census data covering both rural and urban.
The scheme is designed to be dynamic any aspirational and it would take into
account any future changer in the exclusion/inclusion/deprivation/occupational
criteria in the SECC data.

States/Districts covered: AB-PMJAY will be rolled out across all states/ Uts in
all districts with an objective to cover all the targeted beneficiaries.

Impact: According to international rating agency Moody’s Ayushman Bharat is
credit positive for insurance companies as it will aide in higher premium
growth. “The launch of universal health coverage is credit positive for the
country’s insurers because it will help grow health premiums and provide
insurers with cross-selling and servicing opportunities,” Moody’s said in a
report.

British medical journal Lancet has praised Prime Minister Narendra Modi for
prioritizing universal healthcare with his Ayushman Bharat initiative. An
article by the journal’s editor-in-chief Richard Horton appreciated the Modi
government for recognizing the ‘perils of public discontent about health’ after
years of neglect. Modi is the first Indian Prime Minister to priorities
universal health coverage as part of his political platform, Horton wrote in his
article.

How to get covered under Ayushman Bharat Yojana? It’s simple … Just memorize the
helpline number of the Ayushman Bharat Yojana, 14555. PM Modi says this number
must be memorized by every citizen of India. Ayushman Bharat Yojana helpline:
14555.

Conclusion:

The scheme is innovative and path-breaking in the history of public health in
India, which may have a transformative impact if implemented in an effective and
coordinated manner. The scheme will also help in enriching the database of
hospitals registered with the Registry of Hospitals in Network of Insurance
System and the human capital captured under the National Health Resource
Repository project. This can later be used innovatively for improvement of
access to and quality of healthcare service in the country. The scheme will have
a multiplier impact on the healthcare and allied sectors like pharmaceutical,
diagnostics and medical devices and the overall Indian economy by way of
employment generation. In the long run, AB-PMJAY should envision strengthening
of primary care, inclusion of out-patients treatment and a public healthcare
delivery system, and expanding the scope of coverage to the entire population in
order to make the government’s transition from provider to payer a successful
one and achieve Universal Health Coverage in the true sense.